AB0686 THE IMPACT OF SYSTEMIC SCLEROSIS (SSc) ON WOMEN’S HEALTH EVALUATED WITH A NEW SSc-SPECIFIC PATIENT-REPORTED QUESTIONNAIRE.
Authors: M. G. Lazzaroni, L. Moschetti, E. Pedretti, F. Cucchi, A. Lojacono, F. Ramazzotto, C. Zanardini, S. Zatti, A. Tincani, F. Franceschini, P. Airò, L. Andreoli
Journal: Annals of the Rheumatic Diseases (2022)

Background Systemic Sclerosis (SSc) can strongly affect the quality of life of affected women. We aimed at designing a SSc-specific, patient-reported questionnaire to explore different aspects of women’s health. Objectives The questionnaire was created together with Obstetricians-Gynecologists (70 questions, 5 sections) and administered to consecutive patients with SSc (2013 ACR/EULAR classification criteria) regularly attending our Clinic in May-December 2021. The Female Sexual Function Index (FSFI) questionnaire was also administered. Methods The questionnaire was created together with Obstetricians-Gynecologists (70 questions, 5 sections) and administered to consecutive patients with SSc (2013 ACR/EULAR criteria) regularly attending our Clinic in the period May-December 2021. The Female Sexual Function Index (FSFI) questionnaire was also administered. Results Questionnaires were proposed to 114 patients; among 100 who accepted to participate (median age 59.0 [43.0-67.0], median disease duration 11.0 [6.0-17.0] years), 48% had received SSc diagnosis during reproductive age (&lt;45 years). The cutaneous involvement was limited in 75% and anti-centromere were positive in 44%. A regular gynecological follow-up was not declared by 60% of the patients. Considering patients with SSc-diagnosis in reproductive age: 73% never discussed contraceptive methods with their SSc-Clinicians; 63% desired a pregnancy after diagnosis, but 30% did not satisfied the desired family size; about 50% reported they did not know whether a woman with SSc could experience disease worsening or take safe medications during pregnancy, and have children also affected by SSc. 77% of patients declared improvement or stability of SSc manifestations during pregnancy. Table 1 shows the comparison of pregnancies before and after SSc diagnosis, based on data reported by the patients. Regarding sexuality, 59% reported that SSc negatively affected it by vaginal dryness (67%), digital ulcers (37%), gastro-intestinal disease (37%) and dyspnea (20%). Among 39 patients completing FSFI, 67% had sexual dysfunction. Table 1. Results are presented as median [IQR] or number/number available data (%) based on patients answering the question. Continuous variables were compared with Mann-Whitney test; categorical variables with Fisher’s exact test. Total pregnancies (n= 189) Pregnancies after diagnosis (n= 42) Pregnancies before diagnosis (n= 147) p-value OR [95% CI] Maternal age at conception, years 28.0 [24.0-32.0] 32.0 [28.0-39.0] 27.0 [23.0-30.0] &lt; 0.001 Live births 152/189 (80.4) 31/42 (73.8) 121/147 (82.3) 0.221 Cesarean sections 36/135 (26.7) 17/31 (54.8) 19/104 (18.3) &lt; 0.0015.43 [2.30-12.9] Preterm births &lt;37 weeks 32/109 (29.4) 7/32 (21.9) 25/77 (32.5) 0.269 Preterm births &lt;34weeks 7/32 (21.8) 2/7 (28.6) 5/25 (20.0) 0.632 Birth weight, kilograms 3.3 [2.8-3.6] 3.1 [2.5-3.5] 3.3 [3.0-3.7] 0.049 ≥ 1 Adverse Pregnancy Outcomes 15/113 (13.3) 8/31 (25.8) 7/82 (8.5) 0.0163.73 [1.22-11.39] Gestational hypertension 4/113 (3.5) 3/31 (9.7) 1/82 (1.2) 0.062 Preeclampsia 1/113 (0.9) 1/31 (3.2) 0/82 (0.0) 0.274 Eclampsia 0/113 (0.0) 0/31 (0.0) 0/82 (0.0) 1.000 HELLP syndrome 1/113 (0.9) 0/31 (0.0) 1/82 (1.2) 1.000 Gestational diabetes 3/113 (2.7) 2/31 (6.5) 1/82 (1.2) 0.182 Intra Uterine Growth Restriction 4/113 (3.5) 2/31 (6.5) 2/82 (2.4) 0.302 Perinatal deaths 2/134 (1.5) 0/32 (0.0) 2/102 (1.9) 1.000 Neonatal Intensive Care Unit Admission 11/134 (8.2) 6/32 (18.8) 5/102 (4.9) 0.0224.48 [1.27-15.84] Perinatal infections 8/134 (8.2) 3/32 (9.4) 5/102 (4.9) 0.396 Breastfeeding 92/132 (69.7) 22/32 (68.8) 70/100 (70.0) 0.893 Conclusion The newly created specific questionnaire was instrumental to facilitate physician-patient communication about ‘women’s health’, particularly in the field of sexuality which is characterized by a high frequency of dysfunction. Adverse outcomes are possible during SSc pregnancies and should be discussed during the multidisciplinary preconception counselling, along with measures to possibly reduce their risk. Acknowledgements GILS (Gruppo Italiano Lotta Sclerodermia) is kindly acknowledged for supporting the study with a grant. Disclosure of Interests None declared